Thursday, February 28, 2008

Athletic Trainers vs. Trainers

Athletic trainers affiliated with the National Athletic Training Association (NATA) are distancing themselves from Brian McNamee, who has admitted to injecting Roger Clemens with HGH:
The guy who works with boxers is referred to as a trainer, and though he trains boxers, per se, he's a far cry from an athletic trainer who is focused on injury management and injury prevention. We have medical backgrounds and training. And we know the limits of what we can do. We can evaluate and treat an injury, but we never give injections, and we do not prescribe medicine."

Sheridan, 38, first heard the word trainer while watching the 1976 movie Rocky as a youngster. "Did Mick know how to prepare Rocky for the fight? Yes," Sheridan said. "But did Mick know if Rocky had a concussion? Did he know how to evaluate it and treat it? No. But that wasn't his concern. His concern was to prepare Rocky to fight, not medically manage him."
I can imagine a scene in the politically correct version of Rocky 2012:
INT: BOXING RING: CORNER: ROCKY JR. SLUMPS IN THE CORNER

Rocky Jr.: "I can't think out there Mick, I see double, the lights bother me, I have a headache"

Mick Jr.: "What month is it? Snap out of it Rock! What's the date, the day, the year? Tell me the damned months in reverse order Rock!

How to recover from concussion

Some folks require "peace and quiet to recover from a severe concussion", others are able to "shake off a mild concussion", while others simply "brave a concussion".

Tuesday, February 26, 2008

Cumulative Effects=Get it Right the First Time

So, Flyers' forward Simon Gagne is out for the season after returning too early following a concussion this season:
"James Kelly, a concussion specialist at the University of Colorado department of neurosurgery, told Gagne on Wednesday that his initial brain injury had never healed. Consequently, it got progressively worse with subsequent blows to the head.

"It's one concussion," Gagne said Kelly told him. "It got worse and worse. Every time I was getting hit to the head, the symptoms were coming back."

This does not bode well for players like Gerald Wallace, who suffered his 4th concussion in four years:
"Wallace visited a neurologist Tuesday, four days after the forward was knocked unconscious when he was hit in the face with an inadvertent elbow from Sacramento's Mikki Moore. It was Wallace's fourth concussion in four years, an all-too-familiar statistic for football players, but almost unheard of in basketball.

While Wallace is out indefinitely, there are concerns about his long-term health and questions about what can be done to protect him when he returns.

Let's hope that Wallace takes his time coming back. Concussion testing guidelines can only take you so far, but if the players are going to deny symptoms, there isn't much to protect them.

Tuesday, February 19, 2008

Concussion becoming an common adjective?

Concussions have become so commonplace, the term is being used as an analogy outside of the sports pages. From food descriptions:
"The cucumber was crisp and juicy. Above the sweet, fresh, salty, marine taste of the geoduck, other flavours spun around like the stars of a cartoon concussion"
...to veterinary diagnoses:
"...the owl had been hit by a car about three weeks ago and was sitting on the side of the road with a concussion and an eye injury.
Even in the sports pages, the term needs creative modifiers, as in this minor league re-cap:
"Bell was later taken from the arena on a stretcher, and was hospitalized overnight with what Phoenix coach Brad Church called "an extreme concussion."
Extreme concussion?

Monday, February 18, 2008

Off the Beaten Path

Concussions come from a variety of sources:

Ice-dancing:
"That performance came first despite Chris dropping Frankie on her head while attempting a difficult manoeuvre during training on Friday. "I was really embarrassed. She said it wasn't my fault but she has mild concussion and her neck's been hurting ever since so I still feel like an idiot.:
Acting like a Jackass (link warning: TMI):
"This is not the first time father-of-one Johnny has been taken to hospital following a botched stunt.... while filming Jackass: The Movie in 2002, he was knocked out by one of his castmates and had to be treated for concussion.
Snowmobiling:
"A 13-year-old Mount Vernon boy who was unconscious for nearly 20 minutes after driving a snowmobile off a 20-foot waterfall Sunday was treated and released from St. Joseph Hospital the same day...Family members reported they could not awaken Janicki for nearly 20 minutes after the fall.... he was treated for facial injuries and a concussion
And just getting a cup of coffee:
"A visiting student from Rochester Institute of Technology slipped and fell on the sidewalk in front of the Starbucks Coffee on Saturday. The student hit her head and blood was seen in the snow where she fell... the report said she appeared to be visibly drunk, as were the other people with her, who were said to be extremely intoxicated and less than cooperative. The emergency medical technicians at the scene of the incident said she appeared to have a possible concussion and a small laceration on her head."
Be careful out there!

Sunday, February 17, 2008

The "grim reality"

Being a Philly guy, I suppose I am partial to home-spun news.It may only be two sentences in an article, but Phil Sheriden doesn't waste a word:
"The concussion epidemic in professional ice hockey is another issue that forces us to question just how much we're willing to ignore to enjoy these sports. Watching Simon Gagne follow the path blazed by Eric Lindros and Keith Primeau is slow torture, if you're a fan. Imagine what it must be like for the players.

Sunday, February 10, 2008

Getting the NHL On-board

There is an article on ESPN's web site (also referring to a really interesting video from CBC's Fifth Estate on Chris Benoit), calling on the NHL to "embrace concussion research":
"If the NHL proposed a study or investigation for such an effect, I'd be first in line," Keith Primeau, a 15-year NHL veteran who retired in 2006 because of post-concussion symptoms that still pop up from time to time in his life... "For me, for the day-to-day [post-concussion effects], I think I'm over the worst of it. I've been feeling really good in the last four months. It's been the most comfortable I've been in some time."
Referring to the possible long-term implications of his concussions, Primeau says:
"I've resigned myself to the fact I'm always going to have [symptoms] to deal with, and I hope that they'll be very intermittent, as they've started to become. But I know I'll always have these setbacks. They are a reminder of exactly the price I've paid."

"[Non-concussed players] can't possibly comprehend the severity and long-term ramifications of head injuries... as a sufferer, even I don't know what the ramifications are. I believe at some point in my life there's going to be a consequence; I just hope it's later rather than sooner."
While the NHL has a mandatory concussion testing program, there has never been any data released or published, although it is not known if the blame lies with the NHL or the NHL Players Association.

Friday, February 8, 2008

An Academic Injury

It is great to see a discussion of the social and academic changes following concussion, as found in Brown's newspaper:
Much as they would like to, they cannot treat concussions - the most common prescription is a healthy dose of rest. In time, patients recover on their own. But the meantime can be stressful for collegiate athletes in ways that have no relation to school or sport.

(One student) recalls his injury changing all aspects of his lifestyle - athletic, academic and social.

"I didn't watch TV without my sunglasses on for a month," he says. "You wouldn't believe how it affects your social life."

...one of the harshest symptoms of his concussion was a social awkwardness that accompanied him wherever he went. "It's something that not too many people around you understand," he says. "You don't walk around with a sign up saying, 'I'm concussed.'"

...an injury - especially one as private as a concussion - could intensify the already-demanding pressures of Brown's academic and social environment.

"I think they affect academics not only in terms of material retained, but there is a very real concern that any injury makes you feel very self-conscious, especially within the academic milieu of Brown. You worry you're going to appear dumber than everyone else," she says. "Many injuries are visual - someone's got a cast, someone's got an ice pack - and we have a certain amount of sympathy. But when you have an injury like a concussion, and it isn't necessarily explained to everyone, I think that itself becomes an embarrassment and a frustration."

Wednesday, February 6, 2008

Concussion Treatment?

Folks at the University of Buffalo have come up with a concussion treatment program:
"...the program entails controlled exercise at a level of stress that does not trigger the symptoms. Its effect is to correct imbalances in brain mechanism brought on by the initial blow, which cause the illness and headaches."
It isn't clear how exercise can alter the metabolic cascade following concussion, so it will be interesting to see if this paradoxical "treatment" is helpful.

Friday, February 1, 2008

New ION 4D Helmets in Super Bowl

A few players on the Giants will be wearing the new ION 4D Helmet this Sunday:
"According to the company that makes it, the helmet features a unique design that reduces the risk of concussions... if you look closely at the helmets of the four players on the Giants, offensive linemen David Diehl, Grey Ruegamer and Guy Whimper and long snapper Jay Alford, you'll notice that their helmet looks different than those of their teammates."
Perhaps more interesting is the Riddell Revolution IQ HITS, with:
"Head Impact Telemetry System (HITS™): On-board electronics record every impact, allowing players to upload and evaluate each occurrence on their home computers.... also provides the guidance necessary to understand and address a suspect impact if it is detected."
Researchers are using this helmet to relate the physics of the collision and incidence of concussion:
"Players who look like they have been hit really hard aren't necessarily the ones who will sustain the most brain damage, said Kevin Guskiewicz, professor of exercise and sport science and director of the Sports Medicine Research Laboratory at the University of North Carolina, Chapel Hill. "There's no relationship between the magnitude of the impact and the clinical outcome"

Other findings showed that a single knock to the head at an impact greater than 90g doesn't always result in immediate concussion symptoms, such as headache, nausea, blurred vision or ringing in the ears. In fact, location, not necessarily force, seemed to play a significant role in brain injury. Six out of 13 players that sustained a concussion had experienced impacts at the top of the their head, as opposed to the side."